Research Roundup November 2025: Recently Published Findings From AFSP-Funded Studies

The Research Roundup is a regular update of recently published findings in suicide prevention research. AFSP-funded studies included in this roundup examined how… 

• We can help ease the risk for suicide after hospitalization for people with psychosis disorders
• Nepalese emergency departments can take steps towards addressing suicide risk
• Depression severity play can affect treatment outcomes for Prolonged Grief Disorder, and 
• Brain structure in individuals with mood disorders may play a part in suicidal behavior 

Researcher: Brandon Gaudiano, PhD 
Institution: Butler Hospital/Alpert Medical School of Brown University 
Grant Type: 2019 Standard Research Grant — $100,000 
Grant Title: Post-Hospital Suicide Prevention Intervention for Patients with Schizophrenia-Spectrum Disorders 

People living with schizophrenia and related psychotic disorders have higher rates of suicide and the risk is particularly acute in the weeks and months following psychiatric hospitalization. Despite this, individuals with psychosis are often excluded from suicide prevention research, leaving a major gap in evidence-based interventions for this group. Existing programs rarely account for the cognitive, emotional, and social challenges unique to people with psychosis, such as disorganized thinking, social challenges, stigma, and difficulty adhering to treatment. Developing suicide prevention strategies that meet these needs is crucial, especially during the high-risk transition from the hospital. 

With support from an AFSP grant, Dr. Brandon Gaudiano piloted an adapted version of the Coping Long Term with Active Suicide Program (CLASP) specifically for people with schizophrenia-spectrum disorders, known as CLASP-S. The intervention combines individual therapy, case management, and family or support-person involvement across several in-person and telehealth sessions during the six months following discharge. The approach draws on Acceptance and Commitment Therapy (ACT) principles, which help patients clarify their personal values, set meaningful goals, and build consistency between their values and daily actions alongside practical problem-solving and communication skills to help strengthen support networks. In this pilot randomized trial with 30 patients with psychosis recently hospitalized for suicidal thoughts and behaviors, CLASP-S proved safe and feasible to deliver, with most participants engaging in sessions soon after discharge, when risk was highest. Both suicidal thoughts and behaviors declined during the first three months, and no rehospitalizations, suicide attempts or deaths by suicide linked to the program. Lessons from the pilot suggest that shorter, more frequent sessions and stronger coordination with outpatient providers could further improve engagement, especially given cognitive difficulties common with psychosis. The study represents a crucial step toward developing tailored, evidence-based suicide prevention strategies for people with psychosis navigating one of the most vulnerable periods of recovery. 

Citation: Benz, M.B., Rabasco, A., Everett, Y. et al. Adapting a Suicide Prevention Program for People with Psychosis Following a Psychiatric Hospitalization: Pilot Results and Lessons Learned. Int. J. Cogn. Behav. Ther. (2025). https://doi.org/10.1007/s41811-025-00260-5    

Researcher: Ashley Hagaman, PhD, MPH 
Institution: Yale University 
Grant Type: 2020 Young Investigator Grant — $90,000 
Grant Title: Integrating Suicide Prevention Packages into Task-Shifted Mental Health Interventions in Low-Resourced Contexts 

Globally, most suicide deaths occur in low- and middle-income countries (LMICs), yet most suicide prevention research has been conducted in high-income, Western settings. Emergency departments (EDs) are often the first point of contact for people in suicidal crisis, but the feasibility of suicide screening and referral in resource-limited settings remains poorly understood. In Nepal, suicide remains a major public health issue, with poverty, negative attitudes about suicide, and family conflict often preventing individuals from seeking help. Despite the urgent need, Nepal has no standardized suicide prevention protocols, and ED clinicians face high patient loads and limited mental health resources. Understanding hospital staff feelings towards implementing suicide screening, in addition to what barriers and supports exist, is a critical first step toward designing culturally appropriate, effective prevention programs. 

With her AFSP grant, Dr. Ashley Hagaman conducted a study in a large emergency department in Nepal to assess how ready clinicians feel about screening and referral to care for suicide risk. Over three months, the research team observed clinical care, conducted focus groups and interviews with staff, and surveyed 26 providers. Most clinicians believed suicide prevention was part of their role and felt supported by hospital leadership, yet many expressed a sense of hopelessness about their ability to help. Practical barriers, such as high patient volume, minimal privacy, and lack of specialized training, made screening difficult to implement. Still, staff showed strong motivation to learn and improve. They emphasized the need for dedicated suicide prevention training, better coordination between departments, and more supportive work environments. The findings suggest that effective suicide prevention in Nepal and similar settings must be developed in collaboration with local providers, combining culturally grounded approaches with feasible, system-level changes that empower frontline clinicians to respond confidently and compassionately to people in crisis. 

Citation: Shrestha, A. P., Shrestha, R., Risal, A., Shakya, R., Sigdel, K., Bajracharya, R., Paudel, P., Gumudavelly, D., Egger, E., Zhuang, S., Vijayakumar, L., & Hagaman, A. (2025). Evaluating implementation preparedness for suicide screening and referral in a Nepali emergency department: A mixed-methods study. Implementation research and practice, 6, 26334895251343644. https://doi.org/10.1177/26334895251343644          

Researchers: Drs. Sidney Zisook, Naomi Simon, Charles Reynolds, & Katherine Shear 
Institution: University of California, San Diego; New York University; University of Pittsburgh; Columbia University 
Grant Type: 2013 Linked Standard Researcher Grant — $105,056 
Grant Title: Treating Complicated Grief in Suicide Survivors 

Grief is a natural human response to loss, but for some people, especially those grieving a sudden or traumatic death, such as the loss of a loved one to suicide, the pain can remain so intense and long-lasting that it develops into Prolonged Grief Disorder (PGD). This condition is marked by persistent yearning, emotional numbness, and difficulty returning to daily life, with accompanied by significant distress and functional impairment. Evidence-based treatments like Prolonged Grief Disorder Therapy (PGDT) have been shown to help many people adapt to loss and rebuild meaning, yet some individuals do not experience meaningful relief. Understanding why certain people respond to treatment while others continue to struggle is key to improving care for all bereaved individuals, including suicide loss survivors. Because depression frequently co-occurs with prolonged grief, it may interfere with recovery. Using tools like machine learning, researchers are now able to analyze complex patterns in clinical trial data to identify which factors (e.g., depression severity or functional impairment) predict different treatment outcomes, paving the way toward more personalized and responsive grief care. 

With their Linked Standard Research Grant, a team of AFSP-funded researchers analyzed data from 333 adults with PGD who took part in a 20-week randomized clinical trial testing four treatment conditions for Prolonged Grief Disorder: PGDT with citalopram (an antidepressant), PGDT with placebo, citalopram with clinical management, or placebo with clinical management. Using machine learning, the team identified three distinct treatment trajectories: two groups that showed substantial improvement (one with lower initial symptom severity, one with higher) and a third group with severe symptoms that did not respond to treatment. Differences between people who responded to treatment and those who didn’t became apparent by week eight. The strongest predictors of minimal response were higher baseline depression and greater grief-related functional impairment, while receiving PGDT and having a longer time since the loss were linked with better outcomes. These findings suggest that clinicians should pay particular attention to grieving patients who begin treatment with significant depressive symptoms or major disruptions in daily functioning. For those not showing early progress, especially suicide loss survivors and others experiencing complex grief, adjusting or intensifying care by the second month of treatment may be essential for supporting recovery.  

Citation: Calderon, A., Irwin, M., Simon, N. M., Shear, M. K., Mauro, C., Zisook, S., Reynolds, C. F., 3rd, & Malgaroli, M. (2024). Depression is Associated with Treatment Response Trajectories in Adults with Prolonged Grief Disorder: A Machine Learning Analysis. medRxiv : the preprint server for health sciences, 2024.12.11.24318861. https://doi.org/10.1101/2024.12.11.24318861       

Researcher: Anjali Sankar, PhD 
Institution: Copenhagen University Hospital (Denmark) 
Grant Type: 2024 Early Career Researcher Grant — $140,000 
Grant Title: Identifying Neurobiological Targets for Suicide Prevention in Mood Disorder 

Mood disorders such as depression and bipolar disorder are closely linked to suicide. While most people living with these conditions will never attempt suicide, understanding why some do is essential to improving care and preventing suicide. Recent advances in brain imaging and cognitive research are shedding light on possible biological and psychological markers that may signal heightened vulnerability. One brain region that has drawn particular attention is the ventromedial prefrontal cortex (vmPFC), which is a hub for emotion regulation, decision-making, and impulse control. Alterations in this area may influence how people process distress or recover from strong emotions. At the same time, subtle difficulties in attention and concentration are often observed among those with mood disorders and may also play a role in suicide risk. Identifying how these brain and cognitive factors interact could help researchers better understand the pathways that contribute to suicidal behavior and inform new, personalized approaches to prevention. 

To explore this, Dr. Anjali Sankar used her AFSP grant to examine brain structure and cognitive performance in more than 700 adults with mood disorders participating in research studies in Denmark. Using MRI scans from over 300 participants and cognitive testing data from nearly 500, the team compared individuals with and without a history of suicide attempts. Those who had previously attempted suicide showed smaller volumes in the ventromedial prefrontal cortex, a region known for its role in regulating emotions and controlling impulses. They also exhibited greater attention difficulties, while other cognitive abilities, such as memory and executive function, did not differ significantly. These findings suggest that long-term differences in both brain structure and attention may help explain why some people with mood disorders are more vulnerable to suicidal behavior. Future work could explore how treatments that strengthen emotion regulation or improve attentional control, such as cognitive training, therapy, or brain-based interventions, might reduce suicide risk and support recovery.  
 

Citation: Andreu, H., Miskowiak, K. W., Macoveanu, J., Kessing, L. V., Vieta, E., Knudsen, G. M., Frokjaer, V. G., & Sankar, A. (2025). Reduced ventromedial prefrontal cortex volume and impaired attention associated with past suicide attempts in patients with mood disorders. Journal of Psychiatric Research, 191, 501-506. https://doi.org/https://doi.org/10.1016/j.jpsychires.2025.09.040      

 
Learn more about the AFSP research grants featured in this monthly roundup, as well as others, here.